title: PUVA-bath photochemotherapy and isotretinoin in sclerodermatous graft-versus-host disease.
abstract: Chronic graft-versus-host disease (GVHD) is almost always associated with skin diseases appearing either as lichenoid GVHD, sclerodermatous GVHD (sGVHD) or as eosinophilic fasciitis-like disease. The two latter frequently result in severe and deep sclerosis. Immunosuppressive therapy is of little help in sclerodermatous or eosinophilic fasciitis-like types of GVHD. Based on data showing that PUVA-bath photochemotherapy is effective in the treatment of severe localized sclerosis of the skin, we investigated the efficacy of PUVA-bath photochemotherapy and isotretinoin in sGVHD. In a retrospective study we analyzed fourteen consecutive patients with sGVHD who received PUVA-bath photochemotherapy, five in combination with oral isotretinoin. Seven patients improved and four showed complete remission. Surprisingly, the therapy was complicated by the development of ulcers within the sclerotic plaques during the early periods of treatment. These ulcers cleared in most patients when PUVA-bath photochemotherapy was continued. Thus, PUVA-bath photochemotherapy alone or in combination with isotretinoin may resolve or improve GVHD associated sclerosis in selected patients.
authors.affiliation: Department of Dermatology, Eberhard Karls University, Liebermeisterstr. 25, 72076 Tübingen, Germany.
authors.forename: Kamran
authors.initials: K
authors.lastname: Ghoreschi
authors.forename: Peter
authors.initials: P
authors.lastname: Thomas
authors.forename: Marius
authors.initials: M
authors.lastname: Penovici
authors.forename: Johanna
authors.initials: J
authors.lastname: Ullmann
authors.forename: Christian A
authors.initials: CA
authors.lastname: Sander
authors.forename: Georg
authors.initials: G
authors.lastname: Ledderose
authors.forename: Gerd
authors.initials: G
authors.lastname: Plewig
authors.forename: Hans-Jochem
authors.initials: HJ
authors.lastname: Kolb
authors.forename: Martin
authors.initials: M
authors.lastname: Röcken
mesh_terms: D000328:Adult; D001494:Baths; D002908:Chronic Disease; D003879:Dermatologic Agents / Q000627:therapeutic use*; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D015474:Isotretinoin / Q000627:therapeutic use*; D008730:Methoxsalen / Q000008:administration & dosage; D008875:Middle Aged; D011701:PUVA Therapy; D017319:Photosensitizing Agents / Q000008:administration & dosage; D012598:Sclerosis; D012867:Skin / Q000473:pathology
chemical_list: D003879:Dermatologic Agents; D017319:Photosensitizing Agents; D015474:Isotretinoin; D008730:Methoxsalen